Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

Abstract

Objective: The aim of the prospective longitudinal service evaluation was to reveal the incidence of persistent headache at 18 months following accidental dural puncture with a 16-gauge Tuohy needle. This followed an observation that a subset of female patients was presenting to the local pain medicine clinic with persistent headache following an accidental dural puncture. Background: Two thirds of patients with an accidental dural puncture develop post dural puncture headache that is believed to be a self-limiting condition. There is emerging evidence from retrospective studies that post dural puncture headache can result in persistent headache. Methods: Prospective longitudinal service evaluation in obstetric patients who suffered an accidental dural puncture headache. Patients provided written consent for telephone follow-up at 6, 12, and 18 months. Patients reporting persistent headache were reviewed at a pain medicine clinic for further investigations and management. Results: Over an 18-month period, 45 patients suffered accidental dural puncture. Five patients declined consent. One patient was lost to follow-up. Of the 39 patients who completed follow-up, 12 patients (30%) reported persistent headache at 18 months. Six patients reported new onset headache while 6 patients reported worsening of pre-existing headache. Conclusion: Post dural puncture headache from an accidental dural puncture can no longer be considered a self-limiting condition. Current evidence probably mandates the addition of persistent headache as one of the potential complications of an epidural insertion during informed consent process.